Global Coalition Strives to Expand Access to Key Cancer Medicines in Low-Income Countries

Cancer is a major public health crisis in low- and middle-income countries (LMICs) around the globe, particularly in Africa. Many of these countries lack the necessary healthcare infrastructure—including access to essential cancer medicines—to save lives. Without it, millions of impoverished people are dying.

Case in point: In 2020, more than 3.5 million new cancer cases were diagnosed in low- and lower-middle income countries (LLMICs) and an estimated 2.3 million premature deaths were caused by cancer. Less than half of the cancer medicines on the World Health Organization (WHO) Model List of Essential Medicines are currently available in LLMICs due to costs of on patent medications, lack of generic medications, and support infrastructure needed to administer medications, including diagnostics and clinical care.

“Although medications and treatments are predominantly available for the vast majority of cancers affecting patients in LLMICs, the mere fact that these patients often cannot access them is a travesty,” says ASCP CEO Blair Holladay, PhD, MASCP, SCT(ASCP)^CM. “However, it doesn’t have to be this way, and there are clear paths forward to equitable access.”

To address this critical need, ASCP has joined with the Union for International Cancer Control (UICC), and about 20 other global health partners to establish the Access to Oncology Medicines (ATOM) Coalition. ATOM Coalition partners will work together to achieve the primary goal of engaging generic and biosimilar manufacturers to develop, register, and supply quality-assured essential cancer medicines at affordable prices in ATOM Coalition-focused countries.

This global partnership aims to increase access to quality-assured, essential cancer medicines in LLMICs and help countries develop the capacity for their proper use. The coalition comprises influential organizations and companies from different sectors to address the challenge of access to cancer medicines in LLMICs. Collectively, these organizations currently operate in more than 100 countries and have decades of experience helping improve cancer treatment and care in LMICs.

Why global health matters

International health initiatives such as the ATOM Coalition are created to tackle increasing global health threats, reduce disparities within communities and between nations, and contribute to a world where people live healthier, safer and longer lives. The economic costs alone that are associated with cancer—both immediate healthcare costs and loss of productivity—threatens continued country development and collective and individual prosperity. Deaths from preventable cancers mean catastrophic health expenditures, less income in the household, and potential impoverishment.

“The patient is at the center of all that we do as pathologists and medical laboratory professionals,” Dr. Holladay says. “Through this initiative, cancer patients will benefit from access to the best treatments for their specific cancer, without fiscal or geographic barriers.”

Professor Anil D’Cruz, President of UICC and Director of Oncology at Apollo Hospitals in India, says, “Simply making affordable cancer medicines available does not guarantee that people living with cancer will receive the medicines they need at the right time. This new partnership is set up to ensure that low- and lower-middle income countries get the support they need to receive the essential cancer medicines where they are currently lacking, as well as the training on their use so that their availability becomes sustainable long term and addresses the specific needs of each country with respect to its cancer burden.”

Combined synergies enhance effectiveness

The ATOM Coalition will build upon the UICC’s network of member organizations in selected countries, as well as global- and country-level public and private sector partners with expertise in implementing cancer-focused access programs. This will enhance the effectiveness of the ATOM Coalition partners and enable countries to increase access to diagnostics and essential cancer medicines.

“The challenge of access to cancer medicines in lower-resource settings is a multi-layered one. At the root of the problem lies enduring system-level barriers, including the available capacity and infrastructure to properly diagnose cancer,” says Dr. Cary Adams, CEO of UICC. “That’s why we cannot separate the work to improve access to medicine from that of diagnostics. Strengthening diagnostic pathology is a key focus of the ATOM Coalition, and with the support of ASCP, people diagnosed with cancer will have a fairer chance of survival.”

The coalition partners aim to build a sustainable operating model that facilitates access over time, as breakthroughs occur, to new medicines that can have a significant health impact in LLMICs, while ensuring that today’s effective medicines are more widely available across those countries in a sustainable manner.

As the ATOM Coalition partners work to engage generic and biosimilar manufacturers, their efforts will require a host of activities including

• Work with governments in LLMICs to assess their country’s ability to receive and use cancer medicines, agreeing and then addressing the gaps—be it diagnostics, screening, radiology, nutrition support, etc.—in order to make more medicines available to cancer patients;
• Support governments in LLMICs to develop sustainable health financing, which covers adequate staffing and medicines for cancer treatment;
• Support to ensure laboratories can provide high quality diagnoses by identifying their gaps and implementing the solutions to fill those gaps, such as training, equipment, new testing strategies, etc.
• Implement training and education programs for healthcare workers and supportive care staff on evidence-based treatment guidelines, protocols, and management of adverse reactions;
• Provide support in streamlining regulatory processes, procurement, forecasting, and supply chain management;
• Provide the necessary means to make available new medicines of significant public health importance for LLMICs through voluntary licensing and other channels.

The coalition is structured as an informal alliance which comprises all ATOM Coalition partners and key representatives from target countries and led by a governing council. UICC serves as the lead administrator of the ATOM Coalition and coordinates its partners in their shared ambition to work collectively in target countries. The ATOM Coalition also includes regional and national organizations within its governance structure, ensuring that it properly represents the needs of cancer patients in LLMICs.

During this first phase of operation, the ATOM Coalition is focused on increasing access to medicines in more than half of all countries that are currently classified as LLMICs.

Coalition partners

At present, the partners committed to the ATOM Coalition include the African Organization for Research and Training in Cancer (AORTIC), the American Society for Clinical Oncology (ASCO), the American Society for Clinical Pathology (ASCP), AstraZeneca, BeiGene, BIO Ventures for Global Health (BGVH), Bristol Myers Squibb (BMS), Direct Relief, Health Financing Institute, Gilead Sciences, the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), the International Generic and Biosimilar Medicines Association (IGBA), McCabe Centre for Law & Cancer, the National Comprehensive Cancer Network® (NCCN®), Novartis, Project ECHO (Extension for Community Healthcare Outcomes), Roche, Sanofi, Sylvester Comprehensive Cancer Center Global Oncology, Teva, the Defeat-NCD Partnership, the Max Foundation (Max) and the Union for International Cancer Control (UICC). This list continues to grow. The complete list of ATOM Coalition partners can be found at www.uicc.org/ATOMCoalition.

As it lays the foundation for its future work, the ATOM Coalition has already begun intense discussions and negotiations with all major pharmaceutical manufacturers to identify existing generic medications, as well as on patent medications, that could have the most impact in LLMICs with increased access. As these medications are identified, a rigorous process of manufacture, regulatory, and distribution logistics will ensue which ultimately results in patient access to life-saving medications.

Learn more about the ATOM Coalition and its work at www.uicc.org/ATOMCoalition.